Stanislav Henkin

Early Results of the Meaningful Use Program for Electronic Health Records

The HITECH Act created incentives to encourage adoption of electronic health records. As of May 2012, only 12.2% of 62,226 eligible professionals had attested to meaningful use, including 9.8% of specialists and 17.8% of primary care providers.

Impact of the learning curve for endoscopic vein harvest on conduit quality and early graft patency.

BACKGROUND Recent studies have suggested that endoscopic vein harvest (EVH) compromises graft patency. To test whether the learning curve for EVH alters conduit integrity owing to increased trauma compared with an open harvest, we analyzed the quality and early patency of conduits procured by technicians with varying EVH experience. METHODS During coronary artery bypass grafting, veins were harvested open (n=10) or by EVH (n=85) performed by experienced (>900 cases, >30/month) versus novice<100 cases, <3/month) technicians. Harvested conduits were imaged intraoperatively using optical coherence tomography and on day 5 to assess graft patency using computed tomographic angiography. RESULTS Conduits from experienced (n=55) versus novice (n=30) harvesters had similar lengths (33 versus 34 cm) and harvest times (32.4 versus 31.8 minutes). Conduit injury was noted in both EVH groups with similar distribution among disruption of the adventitia (62%), intimal tears at branch points (23%), and intimal or medial dissections (15%), but the incidence of these injuries was less with experienced harvesters and rare in veins procured with an open technique. Overall, the rate of graft attrition was similar between the two EVH groups (6.45% versus 4.34% of grafts; p=0.552). However, vein grafts with at least 4 intimal or medial dissections showed significantly worse patency (67% versus 96% patency; p=0.05). CONCLUSIONS High-resolution imaging confirmed that technicians inexperienced with EVH are more likely to cause intimal and deep vessel injury to the saphenous vein graft, which increases graft failure risk. Endoscopic vein harvest remains the most common technique for conduit harvest, making efforts to better monitor the learning curve an important public health issue.

A case-control study of body mass index and asthma in Asian children

BACKGROUND The prevalence of obesity and asthma in the United States has increased in past decades. Numerous studies have focused on the relationship between the 2 factors. However, to our knowledge, this association in Asian Americans has not been extensively studied. OBJECTIVE To assess the association between body mass index (BMI) and asthma in an Asian American pediatric population. METHODS We conducted a case-control medical record review study of 94 pediatric patients with and without asthma at Tufts-New England Medical Center, Boston, Massachusetts. The BMI of asthmatic children before and after their asthma diagnosis was compared with the BMI of children without asthma. RESULTS Multiple analyses showed no significant (P > .05) association between various measures of BMI and asthma in this population. After adjustment for atopic dermatitis, allergic rhinitis, and other allergies, the odds ratio in our longitudinal analysis using BMI greater than the 85th percentile for asthmatic children vs nonasthmatic children was 0.92 (95% confidence interval, 0.40-2.20). CONCLUSIONS Either overweight and obesity do not lead to asthma in Asian immigrant children, consistent with our results, or something about our method limited our ability to observe the association. In either case, more research in the population is needed.

Use of a support vector machine for categorizing free-text notes: assessment of accuracy across two institutions

BACKGROUND Electronic health record (EHR) users must regularly review large amounts of data in order to make informed clinical decisions, and such review is time-consuming and often overwhelming. Technologies like automated summarization tools, EHR search engines and natural language processing have been shown to help clinicians manage this information. OBJECTIVE To develop a support vector machine (SVM)-based system for identifying EHR progress notes pertaining to diabetes, and to validate it at two institutions. MATERIALS AND METHODS We retrieved 2000 EHR progress notes from patients with diabetes at the Brigham and Womens Hospital (1000 for training and 1000 for testing) and another 1000 notes from the University of Texas Physicians (for validation). We manually annotated all notes and trained a SVM using a bag of words approach. We then used the SVM on the testing and validation sets and evaluated its performance with the area under the curve (AUC) and F statistics. RESULTS The model accurately identified diabetes-related notes in both the Brigham and Womens Hospital testing set (AUC=0.956, F=0.934) and the external University of Texas Faculty Physicians validation set (AUC=0.947, F=0.935). DISCUSSION Overall, the model we developed was quite accurate. Furthermore, it generalized, without loss of accuracy, to another institution with a different EHR and a distinct patient and provider population. CONCLUSIONS It is possible to use a SVM-based classifier to identify EHR progress notes pertaining to diabetes, and the model generalizes well.

Use of an Electronic Problem List by Primary Care Providers and Specialists

ABSTRACTBACKGROUNDAccurate patient problem lists are valuable tools for improving the quality of care, enabling clinical decision support, and facilitating research and quality measurement. However, problem lists are frequently inaccurate and out-of-date and use varies widely across providers.OBJECTIVEOur goal was to assess provider use of an electronic problem list and identify differences in usage between medical specialties.DESIGNChart review of a random sample of 100,000 patients who had received care in the past two years at a Boston-based academic medical center.PARTICIPANTSCounts were collected of all notes and problems added for each patient from 1/1/2002 to 4/30/2010. For each entry, the recording provider and the clinic in which the entry was recorded was collected. We used the Healthcare Provider Taxonomy Code Set to categorize each clinic by specialty.MAIN MEASURESWe analyzed the problem list use across specialties, controlling for note volume as a proxy for visits.KEY RESULTSA total of 2,264,051 notes and 158,105 problems were recorded in the electronic medical record for this population during the study period. Primary care providers added 82.3% of all problems, despite writing only 40.4% of all notes. Of all patients, 49.1% had an assigned primary care provider (PCP) affiliated with the hospital; patients with a PCP had an average of 4.7 documented problems compared to 1.5 problems for patients without a PCP.CONCLUSIONSPrimary care providers were responsible for the majority of problem documentation; surgical and medical specialists and subspecialists recorded a disproportionately small number of problems on the problem list.

Increasing Patient Engagement: Patients’ Responses to Viewing Problem Lists Online

OBJECTIVE To characterize the opinions, emotions, and actions taken by patients who viewed their electronic problem list via an online personal health record (PHR). MATERIALS AND METHODS An online survey of patients who viewed their problem lists, as maintained by their healthcare provider, in a web-based PHR linked to an electronic health record for the first time. RESULTS A total 3,649 patients completed the survey, yielding a response rate of 42.1%. Patient attitudes towards the problem list function were positive overall, with 90.4% rating it at least somewhat useful and 86.7% reporting they would probably or definitely use it again. Nearly half (45.6%) of patients identified at least one major or minor problem missing from their list. After viewing the list, 56.1% of patients reported taking at least one action in response, with 32.4% of patients reporting that they researched a condition on the Internet, 18.3% reported that they contacted their healthcare provider and 16.7% reported changing or planning to change a health behavior (patients could report multiple actions). 64.7% of patients reported feeling at least somewhat happy while viewing their problem list, though others reported feeling sad (30.4%), worried (35.7%) or scared (23.8%) (patients could report multiple emotions). A smaller number of patients reported feeling angry (16.6%) or ashamed (14.3%). Patients who experienced an emotional response were more likely to take action. CONCLUSION Overall, patients found the ability to view their problem lists very useful and took action in response to the information. However, some had negative emotions. More research is needed into optimal strategies for supporting patients receiving this information.

Direct to consumer advertising of robotic heart bypass surgery

Robotic assisted coronary artery bypass (r-CABG) is a relatively novel and less invasive surgery. A yearlong direct-to-consumer advertising (DTCA) campaign was initiated to provide the community with information regarding r-CABG, increase awareness, and recruit patients. In order to optimize information content and ensure appropriate messaging for future campaigns, we (a) analyzed the campaign effectiveness, and compared (b) service quality perceptions and (c) clinical outcomes following surgery across DTCA-responder and control groups.